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Residents of assisted living facilities with a full-time RN are less likely to leave the facility for a nursing home

Many frail elderly people who live in assisted living facilities (ALFs) eventually have to leave that facility for a nursing home. According to a recent study involving a national sample of ALFs, over three-fourths (78 percent) of elderly individuals leaving their ALF did so because they needed more care, while 31 percent left because of dissatisfaction with some aspect of the facility.

Residents who had severe cognitive impairment were over twice as likely to enter a nursing home as those who were cognitively intact or had only mild impairment. Also, those who received assistance or supervision with bathing, dressing, or other activities of daily living (ADLs) were significantly more likely to enter a nursing home or to die than those who needed no ADL assistance in the assisted living facility.

Facility characteristics also influenced the likelihood of leaving the ALF for a nursing home. Residents of ALFs with a full-time registered nurse (RN) had less than half the odds of moving to a nursing home compared with residents in facilities that were staffed differently. For people who want to avoid or delay nursing home placement, seeking out an ALF that has full-time RNs on staff may be a good choice in an ALF, suggests Charles D. Phillips, Ph.D., M.P.H., of the School of Rural Public Health at the Texas A & M University System Health Science Center.

The research team—which included William Spector, Ph.D., of the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality—defined ALFs as facilities that provided 24-hour supervision, at least two meals a day, and help in at least two of the following areas of personal need: bathing, medications, or dressing. To explore the impact of resident and facility characteristics on exit from ALFs to nursing homes, the researchers analyzed data on 1,483 residents in a nationally representative sample of 278 ALFs in 1998 and 1999.

In the period between baseline interviews and followup contacts (an average of 7 months), 19 percent of those interviewed died or changed location, whereas 81 percent remained in the same facility in which they resided at baseline. Most surviving residents who left an ALF resided in a nursing facility at followup. The next most common site was another ALF or some other residential care setting.

More details are in "Effects of facility characteristics on departures from assisted living: Results from a national study," by Dr. Phillips, Yolanda Munoz, M.S., Michael Sherman, Ph.D., and others, in the October 2003 Gerontologist 43(5), pp. 690-696.

Reprints (AHRQ Publication No. 04-R019) are available from AHRQ Publications Clearinghouse.

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